N°280 - January 2019
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Arthroscopic repair of a tibial spine fracture by sutures and an absorbable anchor
By Martin CHOLLEY ROULLEAU (1), Olivier GOSSELIN (2) in category TECHNIQUE
(1). Interne des hôpitaux, Nancy / (2). Clinique Claude Bernard, Metz
Tibial spine fracture is an uncommon injury that accounts for 14% of traumas to the anterior cruciate ligament (ACL) (1). It is seen as often in children and adolescents as it is in adults. It occurs most often in menopausal women and growing children (1–7). The mechanism that is most often cited is a forced hyperextension of the knee with simultaneous rotation (2,8). The main causes are found to be traumas due to sport, falls or road traffic accidents (2,4,5,7–10).
After it was described for the first time by Poncet in 1875 (11), Meyers and McKeever wrote the first classification in 1959, amended in 1977 by Zaricznyj (12–14). Type I non-displaced fractures and type II fractures with displacement under 2 mm are the only ones that are treated non-surgically (8). Type II fractures involve an avulsion of one-third to one-half of the anterior portion of the tibial spine. Types III (intact) and IV (comminuted) are completely displaced fractures. Type III has been subdivided into type IIIa, displacement only involving the distal end of the ACL, and type IIIb, displacement involving the whole fragment. In children and adolescents the treatment is often non-surgical, requiring a long period of immobilization which exposes the patient to a risk of secondary displacement,...
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